台灣全口植牙聯盟 – Taiwan Full Arch

Cases Study

▋ Introduction
Full-mouth rehabilitation requires the consideration of numerous clinical factors. Key parameters including bone volume and quality, smile line, age, status of remaining dentition, Vertical Dimension (VD), and lip support must be meticulously evaluated, as they fundamentally dictate the direction of the treatment plan.

This case features a 45-year-old male with excessive gingival display (gummy smile) and long clinical roots. Many of his teeth were still restorable. The treatment followed a staged approach involving Alveolar Ridge Preservation (ARP) and Static Computer-Guided Surgery for full-mouth reconstruction, which was successfully completed within approximately one year.

▋ Pre-operative Assessment
During data collection, it is crucial not only to assess which teeth are restorable but also to analyze their strategic value within the overall reconstruction.

Furthermore, a detailed analysis of the smile line and lip support is necessary to determine the appropriate prosthesis design—whether it should be FP-1, FP-2, or FP-3 fixed prostheses.

If significant lip support is required, the design must pivot toward FP-3, RP-4, or RP-5 formats.

For FP-3 designs, the transition line requires extra caution to ensure the junction between the prosthesis and the natural gingiva remains hidden when the patient smiles.

▋ Provisionalization
Fixed provisional prostheses were delivered on the day of surgery to allow for esthetic adjustments and soft tissue contouring. Based on the smile line and lip support analysis, the patient was identified as an ideal candidate for an FP-1 prosthesis.

▋ Guided Full-Mouth Implant Surgery
Support System: The remaining teeth were well-distributed and stable (non-mobile), making the case suitable for a tooth-supported surgical guide.

Staged Approach: Following a six-month healing period for bone graft maturation, full-mouth guided implant surgery was performed.

Loading: After osseointegration, a minimally invasive Stage II surgery was conducted to transition to implant-supported provisional prostheses.

▋ Conclusion
When a patient is younger, has more remaining teeth with long roots, and exhibits a high smile line (excessive gingival display), the clinical preference leans toward conventional bone grafting and implant procedures.

Pre-operative digital diagnostic wax-ups and tooth arrangement analysis are essential to carefully evaluate esthetics and the smile line, ensuring the selection of the most appropriate implant-prosthetic reconstruction method.